This patient accidentally swallowed something corrosive, and has developed a long smooth stricture at the lower end of the esophagus.
Although these can be the result of accidental ingestion of
acid or alkali, many are the result of deliberate attempts at
self-harm. Acids usually produce a coagulation necrosis (through the
denaturing of proteins), forming a coagulum that limits penetration of
the acid to the mucosal layers. Alkalis typically produce a more severe
injury, known as 'liquefaction necrosis'. This involves denaturing of
proteins and saponification of fats, and the injury may penetrate all
layers of the gut. In the latter circumstances, free perforation is a
Accidental ingestion of caustic occurs most often in children who gain
access to household cleaners. There may be associated burns in the
mouth and oro-pharynx. Gastric antral damage is also common. Several
weeks may elapse after ingestion of caustic before stricturing occurs.
Regular bouginage during this time may overcome any severe degree of
stricturing. Long-standing corrosive strictures are associated with a risk (about 10%) of developing malignant change.
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